Many thanks! To clarify at 10:45, when you said do not repeat initial diagnostic tests do you mean not to repeat B12 levels after doing IM replacement? Also what B12 IM and oral treatment do you usually prescribe?
Thank you for your comment. It is a good question. When I said not to repeat the initial diagnostic tests, this does mean not routinely rechecking B12 levels once the intramuscular treatment is started, unless there's a clinical concern. According to NICE, monitoring should focus on clinical response and symptoms rather than on re-testing B12 levels. For vitamin B12 IM treatment, hydroxocobalamin is typically prescribed as the first choice due to its longer retention in the body. For the dose, I would look at the BNF because the dose changes depending on the clinical situation. For example, prophylaxis of macrocytic anaemias associated with B12 deficiency does not require initial loading doses, just maintenance doses every 2-3 months. However, for pernicious anaemia, you do give loading doses, more frequently still if there are neurological symptoms, although in that situation we should be seeking specialist advice. In terms of oral options, I would go for cyanocobalamin, again looking at the BNF as the dose changes depending whether you are treating a dietary vit B12 deficiency due to poor diet or secondary to malabsorption. I hope that this helps 🙏
Thank you for your comment. The dose will depend on the clinical case. This is from the BNF: Intramuscular vit B12 (hydroxocobalamin) Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency By intramuscular injection Adult 1 mg every 2-3 months. Pernicious anaemia and other macrocytic anaemias without neurological involvement By intramuscular injection Adult Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2-3 months. Pernicious anaemia and other macrocytic anaemias with neurological involvement By intramuscular injection Adult Initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months. Oral vit B12 (cyanocobalamin): Dietary vitamin B12 deficiency By mouth Adult 50-150 micrograms once daily, dose to be taken between meals, dose may be increased as clinically indicated. Dietary vitamin B12 deficiency during pregnancy or breast feeding By mouth Adult 1 mg once daily, dose to be taken between meals, dose may be increased as clinically indicated. For OROBALIN®: Dietary vitamin B12 deficiency Vitamin B12 deficiency due to malabsorption By mouth Adult Initially 2 mg twice daily until remission, dose to be taken between meals, then maintenance 1 mg once daily, dose to be taken between meals.
Always excellent
Thank you very much for your support. It helps a lot. 🙏
Great always
Thank you for your support. It helps a lot 🙏
Thank you doctor
Thank you very much for your support 🙏
Many thanks! To clarify at 10:45, when you said do not repeat initial diagnostic tests do you mean not to repeat B12 levels after doing IM replacement? Also what B12 IM and oral treatment do you usually prescribe?
Thank you for your comment. It is a good question. When I said not to repeat the initial diagnostic tests, this does mean not routinely rechecking B12 levels once the intramuscular treatment is started, unless there's a clinical concern. According to NICE, monitoring should focus on clinical response and symptoms rather than on re-testing B12 levels.
For vitamin B12 IM treatment, hydroxocobalamin is typically prescribed as the first choice due to its longer retention in the body. For the dose, I would look at the BNF because the dose changes depending on the clinical situation. For example, prophylaxis of macrocytic anaemias associated with B12 deficiency does not require initial loading doses, just maintenance doses every 2-3 months. However, for pernicious anaemia, you do give loading doses, more frequently still if there are neurological symptoms, although in that situation we should be seeking specialist advice. In terms of oral options, I would go for cyanocobalamin, again looking at the BNF as the dose changes depending whether you are treating a dietary vit B12 deficiency due to poor diet or secondary to malabsorption. I hope that this helps 🙏
Why is this missing from the curriculum for Doctor's in training 😢
@@michellecheatley1214 Thank you for your comment and support. I really appreciate it 🙏
Mention the doses of vit b12
Thank you for your comment. The dose will depend on the clinical case. This is from the BNF:
Intramuscular vit B12 (hydroxocobalamin)
Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency
By intramuscular injection
Adult
1 mg every 2-3 months.
Pernicious anaemia and other macrocytic anaemias without neurological involvement
By intramuscular injection
Adult
Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2-3 months.
Pernicious anaemia and other macrocytic anaemias with neurological involvement
By intramuscular injection
Adult
Initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months.
Oral vit B12 (cyanocobalamin):
Dietary vitamin B12 deficiency
By mouth
Adult
50-150 micrograms once daily, dose to be taken between meals, dose may be increased as clinically indicated.
Dietary vitamin B12 deficiency during pregnancy or breast feeding
By mouth
Adult
1 mg once daily, dose to be taken between meals, dose may be increased as clinically indicated.
For OROBALIN®:
Dietary vitamin B12 deficiency
Vitamin B12 deficiency due to malabsorption
By mouth
Adult
Initially 2 mg twice daily until remission, dose to be taken between meals, then maintenance 1 mg once daily, dose to be taken between meals.